B статье изложены современные воззрения на патогенез синдрома грушевидной мышцы, развивающегося при компрессии седалищного нерва в подгрушевидном пространстве и возможности тривиальной ультразвуковой допплерографии в диагностике и контроле эффективности лечения в клинике мануальной терапии.
This study concerns the influence of spondylogenic factors on hemodynamics in the vertebrobasilar system. Two groups of patients with spondylogenic vertebrobasilar insufficiency and discirculatory encephalopathy ( n =57) were included. Complex diagnostics were performed in all participants (ultrasound of the cervical intervertebral disks, MRI, X-ray, duplex scanning of the brachycephalic arteries and veins, МR angiography). It was determined whether the degree of degenerative, dystrophic changes in the cervical spine directly effects extra-vessel compression of the vertebral arteries.
Spondylogenic (discogenic) nerve root syndromes often do not respond well to treatment. There are frequent side effects or drug intolerability, and only short periods of pain relief can be achieved. Thus, patients are not receptive to medication. A group of 40 patients with different clinical symptoms of pain syndrome were investigated in a prospective, double blind, randomized study. The study comprised three stages: recruitment of patients, which was followed by treatment (14 day duration), and outcome evaluation. The patients were divided into two groups: group 1 received epidural steroid injections (nerve blocks) and group 2 received non-steroid treatment, while both groups received manual (musculoskeletal) therapy (58 patients in total). Intensity and quality of the pain were evaluated throughout the therapeutic period. The results indicate that epidural steroid injections in chronic pain of discogenic etiology are highly effective.
Spondylogenic (discogenic) nerve root syndromes often do not respond well to treatment. There are frequent side effects or drug intolerability, and only short periods of pain relief can be achieved. Thus, patients are not receptive to medication. A group of 40 patients with different clinical symptoms of pain syndrome were investigated in a prospective, double blind, randomized study. The study comprised three stages: recruitment of patients, which was followed by treatment (14 day duration), and outcome evaluation. The patients were divided into two groups: group 1 received epidural steroid injections (nerve blocks) and group 2 received non-steroid treatment, while both groups received manual (musculoskeletal) therapy (58 patients in total). Intensity and quality of the pain were evaluated throughout the therapeutic period. The results indicate that epidural steroid injections in chronic pain of discogenic etiology are highly effective.
One thousand and thirty patients with proved L(5)/S(1)disc herniations were examined. The dynamics of disease in acute stage was studied using ultrasonography and electromyography in 3 groups of patients: 280 with lumboischialgia, 520 with the root syndrome and 230 controls without back pain. It has been shown that edematous epiduritis and venous stas in the superincumbent spinal movement segment is a main pathogenetic mechanism of acute phase of the disc-radicular conflict. Focal myelopathy is a pathogenetic mechanism of radiculopathy in the disc-recticular conflict. Compression and reflex syndromes are caused by the common mechanisms and their differentiation by clinical presentations has a conditional character.
Ethiopathological and clinical factors of vertebral blood flow insufficiency development are discussed in the article. Distinct connection between pathogenesis and stages of clinical manifestation is proved and nosological independence of vertebrobasilar disease is validated. Used in combined therapy of patients with the disease, cavinton is shown to exert a positive effect on the main clinical symptoms.
50 patients with different neurological manifestations of lumbar osteochondrosis were examined. A new method of transabdominal ultrasonographic investigation of both the discs and the surrounding tissues was applied. 30 cases of discogenic disease and 20 cases of reflex algesic syndrome were revealed. Possibilities of transabdominal ultrasonography for staging the diseases were demonstrated as well as the advantage of the method over computer magnetic-resonance tomography. Ultrasonography allows to visualize rupture of the disc and fibrous changes. The results of the study can be used for diagnosis of the severity of disease as well as for its therapy and prognosis.
50 patients with different neurological manifestations of lumbar osteochondrosis were examined. A new method of transabdominal ultrasonographic investigation of both the discs and the surrounding tissues was applied. 30 cases of discogenic disease and 20 cases of reflex algesic syndrome were revealed. Possibilities of transabdominal ultrasonography for staging the diseases were demonstrated as well as the advantage of the method over computer magnetic-resonance tomography. Ultrasonography allows to visualize rupture of the disc and fibrous changes. The results of the study can be used for diagnosis of the severity of disease as well as for its therapy and prognosis.
The paper is concerned with the development and specification of diagnostic approaches to patients with the title pathology. 168 patients with vascular syndromes of cervical osteochondrosis were under observation. According to the readings of ultrasound echocardiography and ultrasound double scanning, the patients were distributed into two groups: with occlusions and hemodynamically significant stenoses (from 50 to 99%) in the vertebral arteries, and without hemodynamically significant stenoses. On comparison of these two groups of patients with the disease clinical picture the first group patients demonstrated the signs of static or dynamic ataxia of varying gravity, thus allowing confirmation of the existence of the compression form of the vertebral artery syndrome--vertebrobasilar insufficiency. The authors have elaborated a complex of the treatment measures for patients with vascular syndromes of spinal osteochondrosis, including the use of medicamentous and nontraditional means (manual therapy, acupuncture), providing a possibility of carrying out successful conservative therapy. The role of vegetative formations located in the cervical part of the spine in regulation of the cerebral blood flow has been revealed.
